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Month: January 2019

Don has been my close friend and mentor for 50 years. I first met Don as a nurse in the Mission Emergency Room, San Francisco General Hospital, while pursing my premedical studies. His commitment to patient care and advocacy for the underserved populations in the city was incredible. He is the reason I, and many others, found trauma surgery such a gratifying pathway in our surgical careers.

He has been a phenomenal mentor to scores of young surgeons throughout the world, both with his enthusiasm for and experience in trauma surgery. He has set the gold standard for excellence in trauma care- both the art and the science of trauma care. He is the ultimate educator, always willing to take time to share his expertise with all levels of medical providers, prehospital and hospital.

He has been a relentless patient advocate. He has never been afraid to confront the ethical challenges of delivering the highest quality of trauma care, such as “the issue of “preventable trauma deaths”. His publications on the many challenging areas of trauma surgery are held in high regard by surgeons worldwide.

Don is the “grandfather “of global surgery, taking his surgical expertise to vulnerable populations throughout the world, both through his role in the US Army Medical Corp and as a consultant to numerous international trauma communities. He loved to travel and share stories, both personal and professional, with his many international friends.

All of us will always cherish our times with Don, and the impact he has had on the trauma careers of so many of his friends and colleagues.

I first met Dr. Trunkey as an intern at Madigan Army Medical Center in 1988. Dr. Trunkey was doing his active duty training there and he was a Colonel in the US Army Reserve. He spent a significant part of a day teaching in educational conferences and meeting with the residents. As an iconic figure in trauma, I did not expect Dr. Trunkey to take the time to personally get to know each of the residents but this is exactly what he did. I was immediately impressed with his breadth of knowledge and his ability to impart it. I still remember many of the topics we discussed that day and the words of wisdom he imparted

During the time Dr. Trunkey was at Madigan, I was assigned the first case of my career as an operating surgeon, a needle localized breast biopsy and I was shocked to find out that Dr. Trunkey, the famous trauma surgeon, was assigned as the attending. So, essentially, right out of medical school, I was doing a case with 1 of the top 5 trauma surgeons in the country. But it was a breast biopsy, not a GSW to the heart but Dr. Trunkey was very patient with me and even with a breast biopsy, he was able to teach surgical concepts I carried with me for the rest of my career. I considered the case to be a success because a trauma surgeon and a future trauma surgeon completed the case without massive bleeding!

That very brief exposure to Dr. Trunkey at the beginning of my career played a huge role in my decision to become a trauma surgeon in the future. As the Chief of Trauma at OHSU, following in Dr. Trunkey’s footsteps, I feel honored to have learned from Dr. Trunkey and then later to have served as a colleague.

In 1977, I visited several trauma centres in the USA, with particular reference to management of blunt liver injuries and spent three weeks at the San Francisco General Hospital with Don Trunkey. It was there that I witnessed a true resurrection.

On Sunday afternoon 27th November 1977, I was seated in the Emergency Department when a call came through from the Ambulance Service regarding a teenage lad who had received gunshot wounds. He was walking along a footpath with his girlfriend after attending church, when two young teenagers jumped from behind a bush, grabbed the girl’s handbag and shot her. He went forward to resist the robbery whereupon he was shot in the lower abdomen and as he fell forward was shot again in the upper abdomen/chest.

While being transported to the hospital, an intravenous infusion was commenced in his left arm. An ECG of the patient in the ambulance was shown on a screen in the ED while travelling to the hospital (I had never witnessed this previously) and, as the Ambulance entered the hospital driveway, the ECG went flat, indicating cessation of heart beat.

He was immediately transferred to an operating table in the ED, while simultaneously being intubated and ventilated and a catheter inserted into his femoral vein and Don opened the chest. The heart was flaccid and not beating. He began internal cardiac massage which, together with the rapid intravenous fluid infusion and oxygenation via the endotracheal tube, resulted in filling of the heart and restoration of heart beat and circulation. There was a through and through bullet wound of the heart which Don repaired, together with splenectomy due to penetration of the spleen by the bullet. I am a little hazy about the intra-abdominal wound by the first bullet, but believe it was damage to the left iliac vessels which were repaired.

Chatting to the patient and photographing him in bed several days later (photo) made the classification of a “resurrection” to be real.

Don and his wife Jane have been close friends with Judith and myself for over 40 years and we have spent many, many wonderful times together in different parts of the world, which has included our combined love of wines. After some search, I have found a photograph of us together in formal dress (all the others seemed to have shown us with a wine glass in our hand) and one where Don shows his legs wearing a kilt.

I also enclose a photograph of Don in the Australian outback on one of our trips. He is throwing a spear with a special device, generally called a spear thrower, which were often used by Aborigines to increase the distance they could be thrown, with an expert thrower (probably not Don) getting two to three times the distance he could throw without using one. They have a peg at one end where the spear fits in and the thrower holds it by the other end to throw the spear. The spear thrower instrument is called Woomera. The town of Woomera in South Australia was the site where Australia was involved with the British in developing rockets and missiles, which seemed to be an appropriate name for the Indigenous weapon.

Thank you for forwarding to me the information that you have collected about your dad. Back many years ago in the early 1970s, I had invited Don to be one of the lecturers at our annual trauma symposium, which is the oldest trauma symposium in America. At the reception dinner in the middle of the program, I was able to introduce Don to my new, young partner, Dr. Anna Ledgerwood, who grew up in the eastern part of the great state of Washington. Dr. Ledgerwood grew up in farm country where her parents were tenet farmers just outside of Pomeroy. Although we were not able to confirm definitely, Dr. Ledgerwood told us that her brother Mike probably competed against your dad on the basketball court when they were in high school. Needless to say, there was an immediate lifelong connection. Incidentally, Dr. Ledgerwood is still my partner and always keeping me out of trouble.

You are very fortunate to be brought up by Don and Jane. Both are wonderful people. Recently, I had the assignment of expressing my views on the most important trauma and acute care surgeons that I have worked with in my lifetime. Rather than talk about all of the accomplishments that your dad achieved in his career, I believe that I can best summarize my thoughts of Don as it relates to this assignment that I accepted. In the carrying out of this assignment, I identified the most important trauma and acute care surgeon by decade. For the decade before Don and myself, I identified that the most important trauma/acute care surgeon in the world was Tom Shires. As you know, Dr. Shires was a very important surgeon in Don’s academic development after Don spent a research fellowship with Dr. Shires while he was still in Dallas, Texas.

The most important surgeon for my decade was Don Trunkey. I summarized many of his national and international contributions, which are all nicely summarized by other authors who have contributed to your collection of information about your dad. Thus, I call Don the world’s most important trauma/acute care surgeon who was born in the 1930s. What more can I say about your dad!

More important than all of his surgical contributions to the world, Don Trunkey is an outstanding human being. In the midst of all his scientific accomplishments, your dad was always a fun-loving individual who praised generously, accepted criticism graciously, and always was there to help somebody. As I think of your dad, I remember many situations where he went out of his way to help somebody, whether it was a student, a resident, or some stranger walking on the street without knowing exactly where to go. Throughout all of these encounters, he was always humble.

When he was at a national meeting and some admiring resident would finally build up enough courage to ask him a question, he always quizzed the resident about his background until they were able to identify surgeons that both of them knew. Don would then tell stories about that particular surgeon, and by the time they had finished their conversation, the young, shy resident knew that he had a new, lifelong friend. He would also answer the question that led to the resident approaching him in the first place.

When a practicing surgeon, be he a trauma surgeon or a surgeon who does not do much trauma, would stop to ask Don a question, it usually meant it was about a patient who had complications related to some surgical problem. Don would recognize that instantly and described some of the difficult cases he had that were similar to the patient they would be talking about. In his humility, Don would always identify some things that he did that, in retrospect, he would have done differently. The surgeon who started the conversation always felt rewarded and better informed because of Don’s lengthy discussion.

Whenever Don was discussing a paper at a national meeting, he always went out of his way to succinctly support the presenter and co-authors and then go ahead and give his own opinions, which often were different than the authors. This was always done with great dignity and with great kindness to the authors who were presenting their own biases about the treatment of some particular surgical disease.

He was always fun-loving. I remember when I was at your place, which was next to the river. And Don would talk about floating down the river with an inner tube like a teenager might do. He was never too important to have fun like a youngster and to share in that fun with his gray-haired colleagues.

One of his greatest traits was his empathy for somebody who was in the midst of a crisis. His words and the look in his eyes always came from the heart as he shared in the painful experience of the other person’s crisis.

In summary, Don Trunkey had wonderful parentage, and he chose a wonderful woman to be his wife.

I first met Don Trunkey when I was a resident in Surgery in Texas. He was a few years older than me, and was always very cordial and gracious. Many aspects of our career were similar. We both did broad based surgery, but had a particular interest in the organization of trauma care. I would not in any way want to infer that my impact in that regard is anywhere near that of Don, but it allowed me to understand the passion he felt for that cause. Through the years, Don was a visitor in Kentucky on numerous occasions. He and Jane were always great friends, and my late wife, Suzanne, really enjoyed them both. She was particularly fond of Jane.

One could look at a curriculum vitae of a person and glean certain things about their life. In reviewing Don’s life accomplishments, there were certainly many. He was a recognized leader of surgical organizations, and I believe if one asked 100 well-informed surgeons with an interest in trauma, “Who was the most influential person in that field in the last 50 years?”, virtually all would have the similar response of Don Trunkey. That is a tremendous legacy for any individual in any field of endeavor.

However, laudable Don’s accomplishments, they really paled beside the enormous personality that he’s always exhibited. To know Don, even casually, was to never forget him. I can remember numerous dinners that we had informally at various meetings, where he would expound on the virtues of some wine he was making or some new food or beverage (usually the alcohol containing-type) that he had recently encountered. This was always delivered with great gusto and bravado. Don and I have both shared an enormous love of learning beyond medicine throughout our lives. We were always sharing book titles with each other about a variety of topics and genres. Truly, Don’s larger than life persona made him, in my mind, even more remarkable than his many accomplishments in the field of surgery.

It is my understanding that Don is not exactly himself today, but I certainly hope he realizes the great affection I have for him personally. I know many of our mutual friends feel the same way. To have known Don through these many years is to have been blessed with his enormous charisma and charm.

When I arrived to begin my trauma research fellowship at the University of Texas, Southwestern Medical Center in August of 1971, I was assigned to share laboratory space with another trauma fellow. Upon entering the lab, I noticed my new colleague concentrating on the electrical wave forms displayed on the screen of a very complicated piece of machinery. He turned, showed the grin that would become the defining characteristic of his personality, and welcomed me.

Don, my new lab-mate, proceeded to introduce me to all the research team members. I soon met Jane, Kristi and Derek; after my first son was born in February of 1972, Jane became his baby sitter. We had a wonderful professional and personal friendship during that year; fortunately for me, that relationship continued throughout our entire careers.

Don returned to San Francisco General Hospital and I stayed for a second year of research before finishing my training and joining the faculty at the University of Louisville. Don was making major contributions to the knowledge of trauma systems in the late 1970’s and early 1980’s; his advice and guidance were invaluable as I began to develop a trauma system for the state of Kentucky.

I loved watching Don use humor and intelligence to become a surgical leader and to work with him while he became, in my opinion, the foremost academic trauma surgeon of the last half of the 20th and the first two decades of the 21st century.

Most
valuable, though, was the personal relationship with Jane and Don. For nearly
two decades the “Sun-fun family”, our group of four trauma surgeon couples,
vacationed each January on a select Carribean island. We cooked, ate, drank,
told tall tales, made up funny names for one another, and laughed constantly.
Jane and Don set the tone that guided the Sun-funs. To be able to live that
experience was a joy, a privilege, and an honor that I will treasure forever.

Don Trunkey, as my fellow surgical resident Brian Gilchrist liked to say, was Lincolnesque. Always a calm demeanor, always a joke or an anecdote ready, and always leading others where they were afraid to go. Like Lincoln he was tall, lanky, and folksy and was raised in a rural environment among family that favored hard work. And like Lincoln, he rose to the top of his profession. I never heard Don Trunkey character assassinate anyone. The most negative thing, and it’s not even all that negative, I ever heard him say about another surgeon publicly or privately, was, ‘He’s an iconoclast’. Some people might even say that’s a compliment! And that attitude of acceptance permeated down from him into the surgery faculty at Oregon. I consider myself very privileged to have trained with him.

From “Mayberry, John. Pioneers, Heroes, Brooders, Surgeons. American Journal of Surgery, 2019, Published Ahead of Print”

Many physicians can look back in their life and find a pivotal point, an event that changed the direction of their lives. They may even have several such moments. It could be the day they decided to become a physician, or the day they picked their specialty. For me it was the day I decided to finish medical school and become a general surgeon. I would like to say thank you to the man who created that pivot in my career. I might not have had a career in medicine if it were not for the influence of Dr. Donald D. Trunkey during my fourth year of medical school at Oregon Health and Science University (OHSU).

Our medical school curriculum was laid out to do the first two years in the class room learning basic sciences and the second two years in the surrounding hospitals and clinics. I slogged through the first two years awaiting the time when I could actually do the work of a physician. Physicians don’t just sit in lecture halls all day, they help make people well.

I started my third year with a three month clinical rotation in pediatrics. I spent that whole rotation sick. Every bug that came into the clinic was passed on to me. More than one of my weekends were spent hugging the toilet with projectile vomiting. Often the kids couldn’t explain what was wrong, leading me to feel like I was practicing veterinary medicine, where you have to rectify the problem without the help of the patient.

I was happy to move out of pediatrics into a different specialty. My next three month rotation was spent in OB/GYN. Working in OB/GYN, like pediatrics was not an enjoyable experience for me. The smells in the delivery room as well as the clinic were not to my liking. And the redundancy became unbearably monotonous.

My third rotation, internal medicine, was at the Portland VA medical center. During this three month rotation the group of patients I saw kept coming back over and over again with the same problems. It seemed like no one was being healed. We saw patients with lung disease who wouldn’t stop smoking and diabetics who would return in crisis because they wouldn’t take their medications. I felt like I wasn’t making an impact on these patients’ lives because they weren’t getting better.

At this point I was beginning to feel like medicine was not what I thought it was, and what I had been doing was certainly not what I signed up for. I became discouraged. All this work, all those years, and all that money to become a physician, what I wanted since I was a kid, was seemingly not what I wanted after all. I was on the verge of quitting medical school. My heart was no longer in it, which reflected in my medicine rotation grade; marginal with recommendation for another 6 weeks of internal medicine. I was pretty down on medicine.

I had just recorded an album of original music which was a lot of fun. I began to compare the two options: Medicine vs. Music. But quitting medical school is a huge decision with some big consequences. I was on a military scholarship, so what would the Navy do if I quit? How would I feel if I quit? What would my parents think of me if I quit? Could I make a living as a musician? There were a lot of musicians that I knew who were better than me that didn’t eat very well and had to bum a ride to gigs.

I decided I would go ahead and start the next rotation which was my final required block, general surgery. I started on Dr. Trunkey’s service. Here I was on the verge of quitting and I had to do a rotation with the new Chief of the Department of Surgery. He had only been there for about a year at that time, after having been recruited from San Francisco.

As I started my general surgery rotation, knowing nothing about general surgery, I was assigned to my first day in the OR with Dr. Trunkey. Just the two of us. Can you imagine how I felt, as a medical student, who usually trained under residents or junior attendings, to be assigned to work with the head of the surgery department? I prepared by reading about the case and I felt that I was as ready as I could be, but I was a little apprehensive that morning as I left my apartment.

I got to the operating room before Dr. Trunkey. When he arrived, the anesthesiologist was putting the patient to sleep. Dr. Trunkey seemed to be in a bit of a hurry. He looked at me and asked if I had ever put in a Foley catheter before. I said, “No.” I thought he would get on my case for that or snap at the nurse to get the catheter in so we could get going. But, that is not what happened.

The great Dr. Trunkey said, “Go get some gloves and I’ll show you how.” He walked me through the steps and I put in my first Foley catheter. I don’t remember anything else about that day. There is an enormous gap between a medical student and the chief of the department at a teaching hospital. When he took me under his wing and said ‘let me teach you what I know,’ it changed my life.

Maybe all my prior training was taught by a resident who was at the end of his rope, or a junior attending who was nervous about getting bad results, or a post call tired physician. As a medical student, you don’t often get to be the first assistant to a professor. There are just too many other residents and fellows wanting that spot. It was almost like I could hear music playing and angels singing. That day, I experienced what it was like to be a physician. I saw a true leader. I saw the physician I wanted to be.

My attitude took a 180 degree turn that day. The rest of my time on his rotation was one of the best times I had in medical school. On this service, we were fixing things and healing people. If someone came in with appendicitis, we took the appendix out, saved their life and they never had that problem again. If someone crashed their car and ruptured their spleen, we took it out, saved their life, and it would never happen again.

I discovered that I was a fix it man at heart. General surgery was just what I needed. My mind was made up, I would finish medical school and become a surgeon. My grades changed from marginal, to honors after that first day with Dr. Trunkey.

Now my student evaluations said things like: “Energetic, very interested student,” “Constantly came to the OR prepared by reading about the case in advance,” “Increasing fund of knowledge gained by a significant amount of outside reading.”

It is possible to go from being a marginal student to an honors student in only one day. I know because I did it with a simple change of attitude. I did it because one man took me under his wing and showed me what it’s like to be a great surgeon. I went on to practice general surgery for 23 years and now I am teaching other physicians to have a better life with better financial planning.

I don’t know how many medical students, residents, and junior faculty crossed paths with Dr. Trunkey over his career. He graduated from medical school in 1963 when I was only a year old. He stopped practicing medicine in 2007 at about the age of 70 when he was made surgeon emeritus and spent the next 8 years continuing to teach surgeons though lectures before fully retiring. Thousands of physicians were influenced by this one great man, not counting the hundreds of thousands of patients who were benefitted by his teachings in the world of trauma surgery. His influence also had a ripple effect to the thousands of patients I, and others like me, treated because of his influence.

Thanks, Dr. Trunkey, for changing my life and making it possible for me to have a rewarding career in general surgery.

Forever Grateful,

Dr. Cory S. Fawcett

(This article was originally published on Thanksgiving at DrCorySFawcett.com)